Race-neutral eGFR formula moves black patients up on transplant list

According to an article released by the AP in early April 2024, transitions toward a race-neutral calculation for estimated glomerular filtration rate (eGFR) have been critical in improving transplant status for Black Kidney transplant candidates. An estimated 14,300 Black candidates have risen on the transplant list between January 2023 and March 2024, resulting in shorter wait times by an average of two years. Data from the United Network for Organ Sharing (UNOS) also revealed that nearly 3,000 of these patients have already received a transplant.

For decades, healthcare professionals, public health advocates, and equity leaders have identified a host of inequities across the organ transplant system in the United States. Beyond disadvantaging lower-income patients, the transplant system and battery of tests required before getting on the list have disproportionately deterred Black patients from getting organ transplants promptly.

One of the most prominent examples of racial inequity in the organ transplant system was in kidney transplants. Previously, eGFR, the primary measurement to assess kidney function and determine a patient’s eligibility for transplant, included a racial adjustment, which calculated better eGFR rates for Black patients, decreasing their likelihood of organ transplant.

Through long-term advocacy from multiple organizations, including the National Kidney Foundation (NKF) and the American Society of Nephrology, hospitals and healthcare facilities have transitioned to a race-neutral eGFR calculation method.

As reported by the AP and ABC News, these efforts have proven fruitful in improving transplant status for Black kidney transplant candidates. The benefit is likely twofold: in addition to getting a transplant earlier, patients spend less time on dialysis.

While dialysis is a critical tool for patients with chronic kidney disease — especially those who spend a prolonged period on the transplant list — dialysis comes with an additional set of risks. Beyond causing symptoms like fatigue and being a significant financial burden, dialysis also increases the risk of infection.

Although the shift toward race-neutral eGFR calculations has been critical for transplant equity, there is still a long way to go before the system is fair and equitable for patients of all backgrounds.